# CENTRE DENTAL ASSOCIATES, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063531572
- **Authorized official:** JOHN A. WILER D.D.S. (PRESIDENT)
- **Authorized official phone:** (269) 323-3128

## Contact information

- **Practice address:** 621 W CENTRE AVE, PORTAGE, MI 49024-5307
- **Practice address phone:** (269) 323-3128
- **Practice address fax:** (269) 323-2005
- **Mailing address:** 621 W CENTRE AVE, PORTAGE, MI 49024-5307
- **Mailing address phone:** (269) 323-3128
- **Mailing address fax:** (269) 323-2005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 09572 | MI | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1619019700 | DENTIST GENERAL PRACTICE | MI |